The 2001 Guidelines for cholesterol controlIntroduction to the second edition
The truths of this book have remained the same since its publication late in 1998. This update addresses several important new developments in the cholesterol field. National Institute of Health's "Expert Panel" (Adult Treatment Panel-III, or ATP-3), part of the National Cholesterol Education Program, issued a new set of guidelines in 2001. As we shall discuss, the guidelines are flawed and so unnecessarily complicated that the average physician will perceive their message as simply "Just use statins." This is an unfortunate generalization and bad advice, indeed.
A sixth statin drug (generic name cerivastatin; brand name Baycol in the United States, Lipobay elsewhere) reached the US market in 1998. Its manufacturer, Bayer, withdrew Baycol in 2001 after it cause 31 deaths in the United States alone and more worldwide. Then the Washington-based watchdog organization, Public Citizen, headed by Sidney Wolfe, MD, announced that their review of FDA reports had revealed 81 deaths related to the five statins still on the US market. The FDA disputed the figure but did not deny that a significant number of deaths had occurred. Wolfe's group advocated stricter warnings to both doctors and patients for the remaining statins To date the FDA has not responded to this petition. We will follow the situation closely.
Meanwhile, a distressing trend continues: advertising to the general public by companies that manufacture statins. This applies pressure on patients and their doctors to use these drugs, without sufficiently emphasizing their potential hazards. The statin companies continue to sponsor clinical trials costing millions of dollars, in quest of FDA approval for new claims. And why not? Their annual sales, already in the billions, are constantly rising, driving patients' expenditures on drugs to obscene levels in the United States and undoubtedly in other countries as well.
On the positive side, use of niacin has steadily increased, and no new adverse effects have been reported. Those who have read thousands of copies of this book know about niacin's distinctive advantages that set it above statins and all other forms of treatment. They know the short list of reported problems and how each can be avoided or managed. Niacin offers an excellent alternative for patients who are now unwilling to take statins and for doctors who have become wary about their use. In fact, niacin would have been a better choice in the first place.
These are some of the new topics we will discuss:
The 2001 Guidelines for cholesterol control
A new statin: cerivastatin (Baycol, Lipobay)
Withdrawal of cerivastatin (caused deaths)
Health advocacy group calls for statin warnings
Increased statin advertising to the general public
A new time-release niacin (Niaspan)
A new combination (Niaspan + lovastatin)
14th International Symposium: Drugs Affecting Lipid
Metabolism (New York, September 9-12, 2001
Niacin + statin reduce coronary events strikingly
Antioxidants: ineffective; blunt niacin-statin effects.
Homocysteine: much-discussed, unproven risk factor
Obesity epidemic increases diabetes, heart disease
On another subject, a respected publishing associate scolded me for referring to skilled doctors as "good at niacin" and convinced me that I should say "good at using niacin." I agree. Please make this adjustment as you read.
We will correct a few typos and minor errors we (and you) noticed in the first edition. Probably the most effective way to read this second edition is to read the update at the end of each chapter first; keep it in mind as you peruse the chapter's message, then review it again at the end. Since Part II, The Medical Section, is not divided into chapters, we have inserted new information in places and added a closing message.
To distinguish updated information, we are using different type face (Arial), rather than the earlier edition's Times New Roman.
This book can prevent heart attacks and strokes, thus saving lives. Be sure you let its message help your friends and relatives as well as you, the reader. Have them visit our website for general information about the book, to read the Introduction, and to find ordering information.
Please enjoy this second edition, which we hope will help you to stay well and enjoy every day!
Thank you for being here.
-William B. Parsons Jr, MD